VALLEY SDEVALUATION REPORT (ER)School AgeStudent.docx

VALLEY SD
EVALUATION REPORT (ER)
School Age
Student Name:Andrew
Date of Report(mm/dd/yyyy):11/21/2014Date Report Provided
to Parent/Guardian/Surrogate: 4/17/2014
Grade: 10th
Student Birth Date:
5/14/1999
Age: 15
Local Education Agency (LEA):
VALLEY VALLEY SD
School Student is Attending:
Valley High School
Current Educational Program:
Regular Education
County of Residence:
Valley County

Name and Address of Parent/Guardian/Surrogate:Phone(Home):
867-5309
Phone(Work):
Dad/Mom JonesPhone(Cell):
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123 Fun Drive
Email(Home):
Valleytown, PA Email(Work):
Other Information:N/A
Complete Sections 1 through 6 for all students.
If determining eligibility for Specific Learning Disability
(SLD), the SLD component near the end of this document must
be completed and used to complete Sections 5 and 6.
1. REASON(S) FOR REFERRAL:
Andrew is diagnosed with Attention Deficit Disorder and is
currently prescribed medication. He is struggling in several of

his classes. Parents report that it takes Andrew a long time to
get work completed. Andrew was evaluated last spring and
found to be eligible for a 504 protected handicapped plan. Since
that time, difficulties have continued and not really abated to a
point where he can be more successful. Additionally, the
parents have requested a speech/language evaluation. Therefore,
the team has requested and received permission to evaluate
again to determine if Andrew meets the criteria for an
educational disability? If so, is he in need of specially designed
instruction?
2. SOURCES OF EVALUATION DATA - In interpreting
evaluation data, the school must draw upon a variety of data
sources, including those listed below, and carefully consider the
information obtained. Document the information obtained from
the sources below.
A. Evaluations and information provided by the parent of the
student (or documentation of LEA's attempts to obtain parental
input):
Andrew is excellent at historical data and facts he is interested
in. He is extremely unorganized, inept at breaking down long
assignments into small tasks, and is terrible at following what is
due. Math is particularly challenging. Andrew has a highly
evolved vocabulary, is a voracious reader which provides him
with a wealth of communication knowledge, and is an excellent
public speaker (comfortable in front of crowds). He lacks
patience for grammar and developing complex writing. His
ideas are there but he does not do well applying them in written
form. Andrew is mature beyond his years in many ways, is
comfortable with adults, is friendly, and is easy-going. He can
be distant (meaning sometimes not there, daydreaming) and can
be combative to parents (probably typical of teens). Andrew

desperately needs help organizing and keeping up with what the
expectations are (i.e. assignments, homework). He is trying but
because he never seems to catch up, he may give up. It just
takes too long for all he needs to do. Going to school and
completing his homework consumes large amounts of time. He
literally takes hours to do his homework on a daily basis.
Carrying over new information to application and processing is
difficult for him. Difficulties with note taking have also been
noted
(huge gaps in his notes). Parents report that his homework
wouldn't get done if they were not helping him to get started,
organize and stay through completion. Andrew is currently
taking 150 mg of Welbutrin to help with his attention problems.
B. Observations - Include teacher observations and observations
by related services providers, when appropriate:
9th grade teachers: Teacher 1, Spanish I:
Andrew needs to improve his homework, test taking, class
participation, independent work, class preparation, motivation,
and organizational skills. He is on-task about 80% to 100% of
the time. Andrew completes homework most of the time. He is
appropriately placed in this class. Andrew' classroom
performance is below median and unsatisfactory. His behavior,
attitude, and interpersonal skills are good. Andrew has asked for
extra help, has come for extra help during resource time, and
has needed extra time on tests. Focus and follow through seem
to be his weakest areas.
Teacher 2, Algebra I B:
Andrew has poor test taking and independent work skills. He
also has poor math skills. Andrew needs to improve class
participation, oral expression, and attention to task. He is on
task about 80% to 85% of the time. Andrew completes his
homework all of the time. He is appropriately placed in this

class. Andrew' classroom performance is below median and
unsatisfactory. His behavior, attitude, and interpersonal skills
are good. Andrew has asked for extra help and has needed extra
time on tests.
Teacher 3, Honors World History:
Andrew has poor attention to task and instruction. He needs to
improve his test taking, independent work, listening
comprehension, and following directions. Andrew is on task
about 60% of the time. He completes his homework all of the
time. This class is a challenge for Andrew. His classroom
performance is below average yet satisfactory. Andrew'
behavior, attitude, and interpersonal skills are good. Andrew
has asked for extra help and has done extra credit.
SFC Smtih, JROTC:
Andrew is on task about 95% of the time. He completes
homework most of the time. Andrew is properly placed in this
class. His work is better than median. Andrew' behavior,
attitude, and interpersonal skills are good. No work habit needs
were noted.
Seth Lehman, PE:
Andrew , 171036
Andrew is on task about 95% of the time. He is properly placed
in this class. His work is better than median. Andrew' behavior,
attitude, and interpersonal skills are satisfactory. No work habit

needs were noted.
Teacher 4, English 9:
No work habit needs were noted. Andrew is on task about 85%
to 90% of the time. He completes homework all of the time. He
is properly placed in this class. His work is median. Andrew'
behavior, attitude, and interpersonal skills are good.
Teacher 5, Biology:
Andrew' homework, test taking, listening comprehension,
following directions, attention to instruction, and class
preparation need improvement. He is on task about 75% of the
time. Andrew seldom completes homework. He is properly
placed in this class. Andrew' work is below median yet
satisfactory. His behavior, attitude, and interpersonal skills are
good. Andrew has needed extra time on tests.
Teacher Updates as of 10/17/2014: Strengths:
•Great personality
•Fun to be around
•Compliant
•Very bright
•Motivated in JROTC
•Does well with factual based assessments
•Likes the challenge of Raiders
•Accesses teachers for help
Needs:

•Needs to improve time on task
•Needs help with task initiation
•Needs to improve organizational skills
•Needs to improve/use strategies to help with working memory
(e.g. 20 minutes later cannot recall information)
•Difficulty with comprehension
•Needs to go back and review building skills
•Needs help with application and processing of skills
•Needs accommodations to enhance focus
•Needs to improve note taking skills
•Needs to improve organizational/study skills
Grades as of end of 1st marking period 2014-2015 school year:
Andrew , 171036
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Subject

Type Points Grade Class Average Weight Weighted
American Government L2Daily481.0 / 575.084%92%100%84%
American Government L2 (1022/4/30)Grade - C84%92%
College Geometry L2Daily223.5 / 298.075%82%100%75%
College Geometry L2 (3023/4/30)Grade - D75%82%
Conceptual ChemistryDaily224.0 / 252.089%83%100%89%
Conceptual Chemistry (2054/8/30)Grade - B 89%83%
Economics L20.0 / 0.00%0%
Economics L2 (1032/9/30)Grading information is incomplete
English 10 L2Daily359.0 / 419.086%88%100%86%
English 10 L2 (0022/7/30)Grade - B 86%88%
Geometry SupportDaily32.0 / 40.080%89%100%80%
Geometry Support (3028/4/30)Grade - P80%89%
Health & Physical Education 10Daily179.0 /
185.097%96%100%97%
Health & Physical Education 10 (5010/6/30)Grade - A 97%96%
Homeroom0.0 / 0.00%0%
Homeroom (220/30)Grading information is incomplete
JROTC - LET 2Daily161.1 / 175.092%89%100%92%
JROTC - LET 2 (2002/3/30)Grade - B 92%89%
Spanish IIDaily151.0 / 205.074%88%100%74%
Spanish II (4044/3/30)Grade - D74%88%
Study Hall0.0 / 0.00%
C. Recommendations by teachers:
Teachers made the following recommendations:
•Improve focus on tasks and instruction
•Improve follow-through on assignments
•Seek assistance during morning resource time when needed
(e.g. 20 minutes later cannot recall information) and chunking
of assignments

•Needs to go back and review building skills (help to connect
previous information to new information)
D. The student's physical condition (include health, vision,
hearing); social or cultural background; and adaptive behavior
relevant to the student's suspected disability and potential need
for special education:
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Andrew resides with his biological parents and younger brother.
He has been diagnosed with ADHD (as reported by his parents)
and takes Welbutrin. Andrew wears glasses for near
sightedness. He sees a behavioral counselor. English is the
primary language spoken in the home and is Andrew' first
language. Andrew performs basic self-help skills independently
at school. There are no social, cultural, or adaptive behavior
considerations relevant to Andrew' suspected disability or
potential need for special education. There may be a physical
consideration of ADHD.
Educational History: Andrew has always attended school in the
CVSD (Hampden Elementary School, Good Hope Middle
School, and Valley High School). Attendance has always been
appropriate. Andrew has never had discipline issues.

Elementary School: Andrew received a Mid-Year Difficulty
Report in kindergarten. He also received reading clinic in first
grade. Andrew struggled some with independent writing tasks in
4th grade and with applying the writing process in 4th and 5th
grades. Consistency of math work was also weak in
4th grade. There were no teacher comments regarding
inattentive and/or hyperactive/impulsive
behavior.
Middle School: Andrew earned all passing grades in middle
school in all classes. His GPA at the end of
6th grade was 91.3103, at the end of 7th grade was 90.1500, and
at the end of 8th grade was 89.2667. There were no teacher
comments regarding inattentive and/or inattentive/hyperactive
behavior.
E. Assessments - Include, when appropriate, current classroom
based assessments; aptitude and achievement tests; local and/or
state assessments; behavioral assessments; vocational technical
education assessment results; interests, preferences, aptitudes
(for secondary transition); etc.:
Ability:
Andrew was administered the Otis Lennon School Ability Test
in May 2009 while in 4th grade. He earned the following
average standard scores: Verbal - 93, Nonverbal - 93, and Total
- 93.
Andrew was administered the Wechsler Intelligence Scale for
Children-Fourth Edition (WISC-IV) on

4/10/2014 by Jennifer Garvey, school psychologist. The WISC-
IV is an individually administered, comprehensive clinical
instrument for assessing the intelligence of children. The Full
Scale IQ is typically the most representative of general
intellectual functioning. On this testing, Andrew earned a
Full Scale IQ of 114, which falls within the High Average range
of general intellectual functioning and
at the 82nd percentile, meaning that Andrew scored better than
or equal to 82 out of 100 of his same age peers on this scale.
Andrew demonstrated no significant processing deficits on this
assessment; therefore, his skills appear to be evenly developed.
The WISC-IV measures four cognitive processes: verbal
comprehension, perceptual reasoning, working memory, and
processing speed. His scores are reported below:
Composite Scores Summary
Scale
Composite
Score
Percentile
Rank
Qualitative
Description
Verbal Comprehension (VCI)
116
86
High Average

Perceptual Reasoning (PRI)
104
61
Average
Working Memory (WMI)
123
94
Superior
Processing Speed (PSI)
97
42
Average
Full Scale (FSIQ)
114
82
High Average
The Verbal Comprehension Index (VCI) is a measure of verbal
concept formation, verbal reasoning, and knowledge acquired
from one’s environment. It also provides an indication of a
student’s long- term memory skills. The subtests that comprise
this index are Similarities, Vocabulary, and Comprehension.
Andrew earned a VCI of 116, which falls within the High
Average range and at the 86th percentile. His subtest scores are
listed below:
Verbal Comprehension Subtest Score Summary
Subtest
Scaled Score
Similarities

13
Vocabulary
13
Comprehension
13
The Perceptual Reasoning Index (PRI) is a measure of fluid or
novel reasoning, visual processing, and visual-motor
integration. The subtests that comprise this index are Block
Design, Picture Concepts,
and Matrix Reasoning. Andrew earned a PRI of 104, which falls
within the Average range and at the 61st
percentile. His subtest scores are listed below:
Perceptual Reasoning Subtest Score Summary
Subtests
Scaled Score
Block Design
8
Picture Concepts
11
Matrix Reasoning
13
The Working Memory Index (WMI) provides a measure of a
student’s working memory abilities. Tasks that require working
memory require the ability to temporarily retain information in
memory, perform some operation, and produce a result.
Working memory involves attention, concentration, and
reasoning. Working memory is an essential component of

higher-level cognitive processes such as perceptual reasoning
and verbal comprehension. The subtests that comprise this index
are Digit Span and Letter-Number Sequencing. Andrew earned a
WMI of 123, which falls within the Superior range
and at the 94th percentile. His subtest scores are listed below:
Working Memory Subtest Score Summary
Subtests
Scaled Score
Digit Span
14
Letter-Number Sequencing
14
The Processing Speed Index (PSI) provides a measure of a
student’s ability to quickly and correctly scan, sequence, or
discriminate simple visual information. Faster processing of
information conserves working memory. Subtests included in
this index are Coding and Symbol Search. Andrew earned a PSI
of 97, which falls within the Average range and at the 42nd
percentile. His subtest scores are listed below:
Processing Speed Subtest Scores Summary
Subtests
Scaled Score
Coding (CD)
11

Symbol Search (SS)
8
Achievement: Standardized Achievement Assessment:
The Wechsler Individual Achievement Test: Third Edition
(WIAT-III) was administered on 4/10/2014 to assess Andrew's
level of achievement. The WIAT-III is comprised of three broad
achievement areas: reading, math and written language, as well
as a composite for listening comprehension. On the WIAT
-III, standard scores from 85 to 115 are within the average
range.
Subtest/Composite
Standard
Score
Percentile Rank
Qualitative
Description
Listening Comprehension
120
91
Above Average
Receptive Vocabulary
123
94
Above Average
Oral Discourse Comprehension
110
75
Average
Total Reading
121
92

Above Average
Basic Reading
118
88
Above Average
Word Reading
119
90
Above Average
Pseudoword Decoding
113
81
Average
Reading Comprehension
105
63
Average
Oral Reading Fluency
128
97
Above Average
Oral Reading Accuracy
130
98
Superior
Oral Reading Rate
125
95
Above Average
Written Expression
119
90
Above Average
Essay Composition
100
50

Average
Word Count
100
50
Average
Theme Development and Organization
99
47
Average
Grammar and Mechanics
108
70
Average
Sentence Composition
120
91
Above Average
Sentence Combining
121
92
Above Average
Sentence Building
113
81
Average
Spelling
124
95
Above Average
Mathematics
114
82
Average
Math Problem Solving
117
87

Above Average
Numerical Operations
109
73
Average
Math Fluency
102
55
Average
Math Fluency—Addition
107
68
Average
Math Fluency—Subtraction
99
47
Average
Math Fluency—Multiplication
100
50
Average
Andrew’s listening comprehension skills are within the above
average range. His receptive vocabulary is also within the above
average range, and his ability to listen to oral discourse and
answer questions about it is average.
Andrew’s overall reading skills are within the above average
range. His basic reading skills are above average, and reading
comprehension is within the average range. Andrew’s oral
reading fluency is above average, with both his rate of oral
reading and reading accuracy being evenly developed. His sight
vocabulary is above average, and his ability to decode
unfamiliar words is within the average range.

Andrew’s overall written expression is within the above average
range. His essay composition is within the average range, and
his sentence composition is above average. On the essay, his
theme development and text organization, as well as grammar
and mechanics are both average. His length of writing is also
average. His ability to spell single-word responses is in the
above average range.
Andrew’s overall math skills are within the average range. His
math problem solving skills are above average, and his math
calculation is average. His math fluency is within the average
range, with addition, subtraction, and multiplication all being
evenly developed.
State Assessments (PSSA):
8th Grade:
Math - Advanced Reading - Advanced Science - Advanced
Writing - Proficient
7th Grade:
Math - Advanced
Reading - Advanced
6th Grade:
Math - Advanced
Reading - Advanced
5th Grade:
Math - Advanced Reading - Proficient Writing - Proficient

4th Grade:
Math - Advanced Reading - Proficient Science - Advanced
3rd Grade:
Math - Advanced
Reading - Proficient
Local Assessments:
Gates McGinitie Reading Test (Comprehension subtest):
8th Grade - 94th Percentile (Advanced)
7th Grade - 99th Percentile (Advanced)
AIMSweb Oral Reading Fluency:
5th grade - 211 words per minute (Established)
AIMSweb Math Computation Fluency:
5th Grade - 56 raw score (Established)
Developmental Reading Assessment-Second Edition:
5th Grade - level 50 (Meets Expectations)
Classroom-Based Assessments:
9th Grade
1st Marking Period
2nd Marking Period
3rd Marking Period
English 9 L2
85
86
83
Honors World History
84
87

83
JROTC – LET 1
94
89
90
Biology L2
87
77
76
Basic Algebra I B
80
73
82
Spanish I
84
73
80
Health & PE 9
95
89
99
Group Guidance
100
100
93
Social/Emotional/Behavioral:
Mrs. Jones, Andrew’s mother, completed the Achenbach
Behavior Checklist to assess Andrew’s level of emotional or
behavioral difficulties at home. She rated Andrew as within

normal limits for all areas assessed. Results are detailed below.
(T-scores from 40 to 64 are within normal limits. T-scores of 65
to 70 are borderline significant. T-scores above 70 are clinically
significant.)
T-scores
Descriptors
Anxious/Depressed
50
Average
Withdrawn/Depressed
53
Average
Somatic Complaints
54
Average
Social Problems
50
Average
Thought Problems
51
Average
Attention Problems
64
Average
Rule-Breaking Behavior
50
Average
Aggressive Behavior

52
Average
DSM-Oriented Scales:
Affective Problems
55
Average
Anxiety Problems
50
Average
Somatic Problems
50
Average
Attention Deficit/Hyperactivity Problems
62
Average
Oppositional Defiant Problems
55
Average
Conduct Problems
51
Average
Three of Andrew’s teachers completed the Conners 3 Short
Form to assess his behaviors at school. The Conners 3 consists
of five areas: inattention, hyperactivity/impulsivity, learning
problems/executive functioning, aggression, and peer relations.
Results are detailed below. *=At-risk **=Clinically Significant
(T-scores from 40 to 59 are within normal limits. T-scores of 60
to 69 are at-risk; and T- scores of 70 and above are considered

clinically significant.) The English teacher rated Andrew as
within normal limits for all areas assessed; however, he notes
that Andrew often does not pay attention to
details and makes careless mistakes. The Biology teacher rated
Andrew as clinically significant in the areas of inattention and
learning problems/executive functioning. She indicated the
following to be very frequently true: inattentive/easily
distracted; has trouble keeping his mind on work for very long;
doesn’t pay attention to details/makes careless mistakes; has a
short attention span; and is sidetracked easily. The World
History teacher rated Andrew as significant for inattention and
peer relations. She reports the following to be often true: poor
social skills; one of the last to be picked for games; does not
know how to make friends. These were not observed to be
problematic by other teachers.
Inattention
Hyperactivity/ Impulsivity
Learning Problems/ Executive Functioning
Aggression
Peer Relations
English
58
43
57
45
45
Biology
83**
49
83**
45
45
World History
72**
53

54
45
>90**
The Brown ADD Scales are based on Dr. Brown's clinical
research and his model of ADD/ADHD as a developmental
impairment of executive functions. The Brown ADD Scales help
to assess a wide range of symptoms of executive function
impairments associated with ADHD/ADD in a normed rating
scale format. The Brown ADD Scales for Adolescents and
Adults include 40 items that assess five clusters
of ADHD-related executive function impairments. The five
clusters include:
· Organizing, Prioritizing and Activating to Work
· Focusing, Sustaining and Shifting Attention to Tasks
· Regulating Alertness, Sustaining Effort and Processing Speed
· Managing Frustration and Modulating Emotions
· Utilizing Working Memory and Accessing Recall
Andrew was rated by his parents in the following manner:
Activation - T score of 65
Attention - T score of 67
Effort - T score of 55
Affect - T score of <50
Memory - T score of 80
Total Score - T score of 62
T scores of 60 to 69 are at risk and T scores of 70 and above are
clinically significant.
The Behavior Rating Inventory of Executive Function (BRIEF)
was also completed in February 2014 to assess Andrew’

executive functioning skills. Executive functions are a
collection of processes that are responsible for guiding,
directing, and managing cognitive, emotional, and behavioral
functions, particularly during problem solving. The clinical
scales measure different aspects of executive functioning
including Inhibit, Shift, Emotional Control, Initiate, Working
Memory, Plan/Organize, Organization of Materials, Task
Completion, and Monitor. There are two broader Indexes,
Behavioral Regulation (ability to shift cognitive set and
modulate emotions and behavior via appropriate inhibitory
control) and Metacognition (ability to initiate, plan, organize,
and sustain future-oriented problem solving in working
memory) as well as an overall score, the Global Executive
Composite (ability to coordinate and apply one’s own mental
capacity).
Andrew’s mother, Mrs. Jones, served as informant on the Parent
Form. Andrew’s ratings are presented below as T scores with a
mean of 50. T scores of 65 or above are considered to be
clinically significant.
Mrs. Jones
Inhibit
45
Shift
51
Emotional Control
41
Behavior Regulation
44
Initiate
63
Working Memory
79
Plan/Organize

72
Organize-Materials
72
Monitor
59
Metacognition Index
72
Global Executive Composite
64
The overall index, the Global Executive Composite (GEC), was
within the expected range for age
(GEC T = 64, %ile = 89). The Behavioral Regulation Index
(BRI) was within normal limits (BRI T =
44, %ile = 43) while the Metacognition Index (MI) was elevated
(MI T = 72, %ile = 97). Within these summary indicators, all of
the individual scales are valid. One or more of the individual
BRIEF scales were elevated, suggesting that Andrew exhibits
difficulty with some aspects of executive function. Concerns are
noted with his ability to sustain working memory (Working
Memory T = 79, %ile = ³
99), plan and organize problem solving approaches
(Plan/Organize T = 72, %ile = 97), and organize
his environment and materials (Organization of Materials T =
72, %ile = ³ 99). Andrew' ability to inhibit impulsive responses
(Inhibit T = 45, %ile = 49), adjust to changes in routine or task
demands (Shift T =
51, %ile = 65), modulate emotions (Emotional Control T = 41,
%ile = 32), initiate problem solving or activity (Initiate T = 63,
%ile = 89), and monitor his own behavior (Monitor T = 59, %ile
= 87) is not described as problematic by the respondent.
Andrew completed the Self-Report Version of the Behavior
Rating Inventory of Executive Function (BRIEF-SR) on

04/10/2014. The overall index, the Global Executive Composite
(GEC), was within the expected range for age and gender (GEC
T = 52, %ile = 58). The Behavioral Regulation Index (BRI) was
within normal limits (BRI T = 39, %ile = 16) while the
Metacognition Index (MI) was mildly elevated (MI T = 63, %ile
= 91).
The Global Executive Composite (GEC) is an overarching
summary score that incorporates all of the BRIEF-SR clinical
scales. The Behavioral Regulation Index (BRI) captures the
adolescent’s ability to shift cognitive set, modulate emotions
and behavior via appropriate inhibitory control, and monitor his
impact on others. It is comprised of the Inhibit, Shift,
Emotional Control and Monitor scales. Intact behavioral
regulation is likely to be a precursor to appropriate
metacognitive problem solving. Behavioral regulation enables
the metacognitive processes to successfully guide active
systematic problem solving; and more generally, behavioral
regulation supports appropriate self-regulation.
The Metacognition Index (MI) reflects the adolescent’s ability
to sustain working memory, to plan and organize his problem-
solving approaches, and to organize his materials and
environment. It can be interpreted as Andrew’ ability to
cognitively self-manage tasks. The MI relates directly to ability
to actively problem solve in a variety of contexts and to
complete tasks such as school work. It is composed of the
Working Memory, Plan/Organize, Organization of Materials,
and Task Completion scales.
Within these summary indicators, all of the individual scales are
valid. One of the individual BRIEF- SR scales was at least
mildly elevated. Concerns are noted with his ability to finish

tasks such as homework or projects (Task Completion T = 74,
%ile = 98). Andrew describes his ability to inhibit impulsive
responses (Inhibit T = 39, %ile = 18), adjust to changes in
routine or task demands (Shift T =
43, %ile = 30), modulate emotions (Emotional Control T = 42,
%ile = 28), sustain working memory (Working Memory T = 56,
%ile = 77), plan and organize problem solving approaches
(Plan/Organize T = 59, %ile = 82), organize his environment
and materials (Organization of Materials T = 56, %ile =
72), and monitor his own behavior (Monitor T = 36, %ile = 9)
as not problematic.
BRIEF-SR™ Score Summary Table
Index/Scale
T Score
Percentile
Descriptor
Inhibit
39
18
Average
Shift
43
30
Average
Emotional Control
42
28
Average
Monitor
36
9
Average
Behavioral Regulation Index (BRI)
39
16
Average

Working Memory
56
77
Average
Plan/Organize
59
82
Average
Organization of Materials
56
72
Average
Task Completion
74
98
Elevated
Metacognition Index (MI)
63
91
Mildly Elevated
Global Executive Composite (GEC)
52
58
Average
Speech and Language Assessment – Rachael Ray M.S. CCC-
SLP
A speech-language evaluation was conducted to evaluate
Andrew’ expressive and receptive language skills.

The following standardized assessments were administered to
Andrew by the speech-language pathologist:
Testing Dates: 11/11/14, 11/13/14 - 11/14/14, 11/18/14 –
11/19/14
First, the Clinical Evaluation of Language Fundamentals 5
(CELF-5) was given to Andrew. The CELF-5 is a diagnostic
battery for assessing a student’s use of and understanding of
language through a variety of content. The test uses 8 subtests
to measure the student’s skills and then subsequently uses
those scores to determine a: core language score, receptive
language index, expressive language index, language content
index, and language memory index. Andrew’ results on each
subtest were as follows:
Subtest:
Raw Score
Scaled Score
Word Classes
39
14
Following Directions
26
8
Formulated Sentences

48
16
Recalling Sentences
76
16
Understanding Spoken
Paragraphs
18
14
Word Definitions
20
17
Sentence Assembly
16
10
Semantic Relationships
17
11
According to normative data collected in the CELF-5, a scaled

score of 8-12 is considered average and a scaled score of 13 and
above is considered above average for each subtest. Therefore,
Andrew scored average on 3 subtests and above average on 5
subtests. Specific subtest scores were then combined to form
core language and index scores for Andrew’ age group; results
are as follows:
Sum of subtest Scaled ScoresStandard Score
Core Language Score46109
Receptive Language Index39118
Expressive Language Index42124
Language Content Index2488
Language Memory Index40120
To determine if there is evidence of a language disorder, a core
language/index score with a standard score of 86 to 114 is
classified as average and a score of 115 and above is classified
as above average on p.153 of the CELF-5 examiner’s manual.
Therefore Andrew’ CELF-5 scores indicate that he is average
and above average in his tested receptive/expressive language
skills on this assessment.
Next, the speech-language pathologist administered the The
Listening Comprehension Test Adolescent to Andrew. This
assessment measures a student’s ability to process auditory
information through listening comprehension skills. The
following subtest scores reflected Andrew’ ability to listen to a
story or message and answer questions; his results are captured

in the following table:
Main Idea
Details
Reasoning
Vocabulary and
Semantics
Understanding
Messages
Total Test
Raw Score
12
15
15
15
14

71
Age Equivalent
>15-4
>16-8
>15-8
>16-0
>17-11
>18-4
Percentile Rank
93
94
93
93
87
95
Standard Score
123
123

122
122
117
124
Based on normative data of the The Listening Comprehension
Test Adolescent, the standard scores have a mean of 100 and a
standard deviation of 15. Therefore standard scores that fall in
between 85 and 115 are considered average; all of Andrew’
standard scores were above average for listening comprehension
and processing of auditory information.
During the last testing session, the Test of Language
Development-Intermediate: Fourth Edition (TOLD-I:4) was
given to Andrew. The TOLD-I:4 assesses a student’s receptive
and expressive language skills through subtests that provide an
objective and standard means of identifying deficiencies in
important language area that make up the ability to
communicate through speech. The results are useful for
diagnosing specific strengths and weakness in oral language.
Scores on this evaluation are as follows:
Subtest:Raw ScoreScaled ScoreDescriptive Terms
Sentence Combining3015Superior
Picture Vocabulary 69 14
Above Average Word Ordering 28 13
Above Average Relational Vocabulary 24 11
Average

Morphological
Comprehension
4014Above Average
Multiple Meanings3912Average
These subtests are then combined to form the Composite
Language Performance. Each composite looks at a different area
of language. The Spoken Language composite score is the most
comprehensive estimate of the student’s overall language
ability.
Composite:Sum of Scaled
Scores
Index ScoresDescriptive Terms
Listening28121Superior
Organizing24110Average
Speaking
27
121
Superior
Grammar
42

124
Superior
Semantics
37
114
Above Average
Spoken Language
79
120
Above Average
Andrew’ results on the TOLD-I:4 conclude that his language
skills are average ranging to above average/superior as
compared to his same-aged peers.
In summary, Andrew is a student whose expressive/receptive
language skills tested in the average to superior range. On the
CELF-5 Andrew scored average to above average for expressive
and receptive language on all subtest and core/index scores. The
Listening Comprehension Test Adolescent revealed that Andrew
is above average in the areas of listening comprehension and
processing of auditory information. Lastly, the TOLD-I:4
indicated that Andrew’ language skills areas are average to
superior on all subtest and index scores.
Based on those results, he does not qualify for speech-language

services at this time.
3. IF AN ASSESSMENT IS NOT CONDUCTED UNDER
STANDARD CONDITIONS, DESCRIBE THE EXTENT TO
WHICH IT VARIED FROM STANDARD CONDITIONS
(including if the assessment was given in the student's native
language or other mode of communication):
All assessments were conducted under standard conditions.
4. DETERMINING FACTORS - A student must not be found to
be eligible for special education and related services if the
determining factor for the student's disability is any of those
listed below. Respond Yes or No to, and provide evidence for,
each determining factor below.
Yes NoLack of appropriate instruction in reading, including the
essential components of reading instructions. Provide evidence:
The student has received appropriate instruction utilizing
research-based instructional strategies and materials in the core
balanced-literacy program. The student received instruction that
emphasized the essential components of reading - namely
phonemic awareness, phonics, vocabulary, fluency, and
comprehension. All teachers employed by the Valley School
District are certified by the Pennsylvania Department of
Education to teach in their area of certification. The principal
and/or supervisor observed the teaching staff to ensure that the
core program was implemented as specified.

Yes NoLack of appropriate instruction in math. Provide
evidence:
The student has received appropriate instruction utilizing
research-based instructional strategies and materials in the core
mathematics program. All teachers employed by the Valley
School District are certified by the Pennsylvania Department of
Education to teach in their area of certification. The principal
observed the teaching staff to ensure that the core program was
implemented as specified.
Yes NoLack English proficiency. Provide evidence:
The student's primary language is English. English is the
primary language spoken in the home.
NOTE: IF DETERMINING ELIGIBILITY FOR SPECIFIC
DISABILITY, COMPLETE THE DETERMINATION OF
SPECIFIC LEARNING DISABILITY COMPONENT AT THE
END OF THIS DOCUMENT BEFORE COMPLETE SECTIONS
5 and 6.
Complete Sections 5 and 6 for all students.
5. SUMMARY OF FINDINGS/INTERPRETATION OF
EVALUATION RESULTS - Considering all available
evaluation data, record the team's analyses of the student's
functioning levels.

A. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT -
Describe the student's present levels, strengths, and the
resulting academic needs, when appropriate. Include
communicative status, motor abilities, and transition needs as
appropriate. For students with limited English proficiency
(LEP), include current level(s) of English language proficiency
in reading, writing, speaking and understanding/listening:
On standardized intelligence testing, Andrew demonstrates high
average verbal comprehension/reasoning skills, average
visual/perceptual reasoning skills, superior auditory working
memory, and average processing speed. He demonstrate no
significant processing deficits that would indicate the potential
of a specific learning disability.
On standardized achievement testing, Andrew’s listening
comprehension skills are within the above average range. His
receptive vocabulary is also within the above average range,
and his ability to listen to oral discourse and answer questions
about it is average.
On standardized achievement testing, Andrew’s overall reading
skills are within the above average range. His basic reading
skills are above average, and reading comprehension is within
the average range. Andrew’s oral reading fluency is above
average, with both his rate of oral reading and reading accuracy
being evenly developed. His sight vocabulary is above average,
and his ability to decode unfamiliar words is within the average
range.
On standardized achievement testing, Andrew’s overall written
expression is within the above average range. His essay
composition is within the average range, and his sentence
composition is above average. On the essay, his theme

development and text organization, as well as grammar and
mechanics are both average. His length of writing is also
average. His ability to spell single-word responses is in the
above average range.
On standardized achievement testing, Andrew’s overall math
skills are within the average range. His math problem solving
skills are above average, and his math calculation is average.
His math fluency is within the average range, with addition,
subtraction, and multiplication all being evenly developed.
Andrew scored in the average range for all areas of the
speech/language evaluation.
B. PRESENT LEVELS OF FUNCTIONAL PERFORMANCE -
Describe the student's present levels, strengths, and the
resulting functional and developmental needs, when
appropriate:
On a functional day-to-day basis in the classroom, some of
Andrew's teachers observe significant attention issues in the
classroom, while others do not. The English teacher reports that
Andrew continually makes the same careless mistakes/errors in
his essay writing.
Andrew reports difficulty with his ability to finish tasks such as
homework or projects. He gets 'stressed' when he has long-term
papers and projects. Although not significant on his self-report
rating scale, Andrew reports that he has trouble getting started
on tasks. He will often procrastinate to avoid the task. In the

classroom, Andrew is aware of when he is not paying attention
to the teacher ('zones out').
C. BEHAVIORAL INFORMATION - Include social and
emotional status and behavioral strengths and needs, when
appropriate:
Andrew has no significant discipline history. He is pleasant,
polite, and well-behaved at school. Andrew's parents completed
a Parent Report and several different rating scales. They rated
him as within normal limits for the majority of the areas
assessed, with no behavioral or emotional problems noted.
Parent observe that Andrew has difficulty maintaining attention,
getting started on tasks, effectively utilizing working memory,
and organizing his time and tasks.
6. CONCLUSIONS - Determination of Eligibility and
Educational Needs
Complete A or B or C.
A. The student does not have a disability and therefore is NOT
ELIGIBLE for special education.
OR
B. The student has a disability but does not need specially
designed instruction, and therefore is NOT ELIGIBLE for
special education.
OR
C. The student has a disability AND is in need of specially
designed instruction, and therefore IS ELIGIBLE for special
education.
1.Disability Category
Primary disability category:Other Health Impairment
Secondary disability category(s), if any:

2.Recommendations for consideration by the IEP team to enable
the student to participate as appropriate in the general education
curriculum (including special considerations the IEP team must
consider before developing the IEP, measurable annual goals,
specially designed instruction, and supplementary aids and
services):
Andrew does not meet the criteria as a student with a specific
learning disability at this time. His overall intelligence is within
the high average range, with no significant processing deficits.
In addition, standardized achievement testing indicates that
Andrew's skills in listening comprehension, basic reading skills,
reading comprehension, reading fluency skills, math
calculation, math problem solving, and written expression are
all within the average range or higher. Therefore, as there is no
significant discrepancy between his ability and acheivement
levels, Andrew does not demonstrate the characteristics of a
specific learning disability.
The school team will meet with Andrew's parents to review
assessment results. Because the 504 plan has been less than
successful, the team has given reconsideration. Andrew
currently meets the criteria for an Other Health Impairment due
to difficulties maintaining attention as well as other related
executive functioning area weaknesses (task initiation,
organizational skills, working memory). An IEP should be
developed to address this deficit areas as they relate to his
learning and educational performance.
Specific areas for IEP consideration:
•Improve focus on tasks and instruction
•Improve follow-through on assignments
•Seek assistance during morning resource time when needed

(e.g. 20 minutes later cannot recall information) and chunking
of assignments
•Needs to go back and review building skills (help to connect
previous information to new information)
Speech/Language:
In summary, Andrew is a student whose expressive/receptive
language skills tested in the average to superior range. On the
CELF-5 Andrew scored average to above average for expressive
and receptive language on all subtest and core/index scores. The
Listening Comprehension Test Adolescent revealed that Andrew
is above average in the areas of listening comprehension and
processing of auditory information. Lastly, the TOLD-I:4
indicated that Andrew’ language skills areas are average to
superior on all subtest and index scores. Based on those results,
he does not qualify for speech-language services at this time.
Evaluation Team Participation
Agreement and Disagreement required ONLY when evaluating
students for specific learning disability.
Evaluation Team Participants*
Title

Agree
Disagree**
Andrew
Student
Dad/Mom Jones
Parent(s)
Bob

School Counselor
Jane, Ed.D.
School Psychologist
.Jill
Regular Education Teacher

Billy Bob
Principal
Francisco
Principal

Rachael Ray
Speech/Language Pathologist

* A certified school psychologist is required for evaluation of
the following disability categories: Autism, Emotional
Disturbance, Intellectual Disability, Multiple Disabilities, Other
Health Impairments, Specific Learning Disability or Traumatic
Brain Injury. A certified school psychologist is not required for
Deaf-blindness, Deaf and Hard of Hearing, Speech/Language
Impairment, Visual Impairment, and Orthopedic Impairment.
** For specific learning disability only, if a team member
disagrees with the team's conclusion related to the identification
of the student as having a specific learning disability, the
member must submit a separate statement presenting the
member's dissent to the LEA. This information must be attached
to the Evaluation Report. Please submit this statement to:
Francisco LEA Representative NamePhone Number
Email Address
A copy of the Procedural Safeguards Notice is available upon
request from your child's school. This document explains your
rights, and includes state and local advocacy organizations that
are available to help you understand your rights and how the
special education process works.
For help in understanding this form, an annotated Evaluation
Report is available on the PaTTAN website at www.pattan.net
Type "Annotated
Forms" in the Search feature on the website. If you do not have
access to the Internet, you can request the annotated form by
calling PaTTAN at

800-441-3215.
DETERMINATION OF SPECIFIC LEARNING DISABILITY
NOTE: This component must be completed when determining
eligibility for Specific Learning Disability. The information
must be attached to and/or incorporated into Sections 5 and 6
of the completed Evaluation Report.
Provide documentation for items 1-10.
1. The student does not achieve adequately for the student's
age or does not meet State-approved grade-level standards in
one or more of the following areas when provided with learning
experiences and scientifically based instruction appropriate for
the student's age or Stateapproved grade level standards and
level of English language proficiency: oral expression, listening
comprehension, written expression, basic reading skill, reading
fluency skills, reading comprehension, mathematics calculation,
and mathematics problem-solving.
2. Check below to identify the process(es) used to determine
eligibility.
Response to Scientific Research-Based Intervention (RtI).
Document the criteria below.
The student does not make sufficient progress to meet age or
State-approved grade-level standards in one or more of these
areas: oral expression, listening comprehension, written
expression, basic reading skill, reading fluency skills, reading
comprehension, mathematics calculation, and mathematics

problem-solving:
Severe Discrepancy between Intellectual Ability and
Achievement. Document the criteria below.
The student exhibits a pattern of strengths and weaknesses in
performance, achievement or both relative to age, standards or
intellectual development:
3. The instructional strategies used and the student-centered
data collected:
4. The educationally relevant medical findings, if any:
5. The effects of the student's environment, culture, or
economic background:
6. Data demonstrating that prior to referral or as part of the
referral process for a specific learning disability, the student's
regular education instruction was delivered by qualified
personnel, including the English as a Second Language (ESL)
program, if applicable:
7. Data based documentation of repeated assessments of
achievement at reasonable intervals, reflecting progress during
instruction, which was provided to the parents:

8. An observation in the student's learning environment
(including the regular classroom setting) to document the
student's academic performance and behavior in the areas of
difficulty. Note the relationship of that behavior to the student's
academic functioning:
9. Other data, if needed, as determined by the evaluation team:
10. Include a statement for each item below to support the
conclusions of the evaluation team that the findings are not
primarily a result of
Visual, hearing, motor disability:
Intellectual Disability:
Emotional disturbance:
Cultural factors:
Environmental or economic disadvantage:

Limited English proficiency:
Upon completion of the SLD Component, attach and/or
incorporate this information into Section 5 and 6 of the
completed Evaluation
Report.
PA SCHOOL DISTRICT
EVALUATION REPORT
Student’s Name: StudentA
1
EVALUATION REPORT (ER) School Age
Student Name: StudentA
Date of Report (mm/dd/yy): April 27, 2009
Date Report Provided to Parent/Guardian/Surrogate: April 28,
2009
Student Birth Date: June 10, 2001
Age: 7 years, 10 months
Grade: 2nd
Local Education Agency (LEA): PA School District

School Student is Attending: Elementary School
Current Educational Program: Regular Education
County of Residence: Franklin
Name and Address of Parent/Guardian/Surrogate:
Phone (Home):
Phone (Work):
Other Information:

PA SCHOOL DISTRICT
EVALUATION REPORT
2
Complete Sections 1 through 6 for all students. If determining
eligibility for Specific
Learning Disability (SLD), the SLD component near the end of
this document must
be completed and used to complete Sections 5 and 6.
1. REASON(S) FOR REFERRAL
StudentA was referred by the school team for inadequate growth
in reading despite instruction
and intervention over a marked period of time.
2. SOURCES OF EVALUATION DATA – In interpreting
evaluation data, the school
must draw upon a variety of data sources, including those listed
below, and carefully
consider the information obtained. Document the information
obtained from the sources
below.
A. Evaluations and information provided by the parent of the
student (or
documentation of LEA’s attempts to obtain parental input):
StudentA’s parents completed a family questionnaire and

indicated the following: StudentA lives
at home with his mother and older brother (age 12). StudentA’s
pre and neo natal periods were
unremarkable and developmental milestones were met within
normal limits. It was noted that
when young, he would throw himself on the floor when upset,
and as an elementary age child, he
stomped and slammed doors. StudentA did have tubes placed in
his ears at age 18 months. No
speech or vision issues were noted, and no motor or medical
concerns were reported. StudentA
was diagnosed with AD/HD at age 6 years by his family doctor
and was currently treated with the
Daytrana patch (15mg). StudentA liked playing games with
other children, riding his bike, 4
wheelers, and go-carts. He also enjoyed swimming. Family
history was significant for AD/HD
and LD.
StudentA’s teacher had discussed StudentA’s reading level and
progress with his mother and she
read with StudentA at home. His teacher also completed a
Vanderbilt rating scale (used by local
doctors to assist in AD/HD diagnoses) in October and in
January. During the parent teacher
conference in the fall, the teacher discussed a plan to help
StudentA to focus on his behaviors.
Each day, the teacher writes in his planner to communicate his
behavior to mother, who signs the
planner each night.
B. Observations – Include teacher observations and observations
by related
services providers, when appropriate:

StudentA’s teacher observed that StudentA had made
improvements in his confidence level since
the beginning of the year and that he no longer told the teacher
that he hated to read. His
behavior was not good during morning hours. Often, StudentA
called out and walked around the
classroom. After lunch, his behavior was somewhat better and
he was slightly more focused. His
teacher also noted that StudentA often does not follow along
when directions are given for an
assignment. He looks around the room and is often out of his
seat. During afternoon subjects, he
does stay in his seat and tries to participate in class discussions.
He usually plays with his peers,
but some days he likes to work on an individual activity, such
as a puzzle. Adaptive skill-wise,
his teacher noted that StudentA has some problems with
communication. He often does not
PA SCHOOL DISTRICT
EVALUATION REPORT
3
respond or he will say that he does not know. In example, he
does not remember what he ate for
breakfast or what he did the night before.
The reading resource teacher observed that StudentA needs
close supervision and one-on-one
assistance. She usually read with him when he was to read

independently in the Phonics for
Reading Level 1 book. She also read with StudentA and
monitored him during Six Minute
Solution
work. She commented that he tries and has made some gains
over the year.
The school counselor observed StudentA on two occasions
during 1st grade. His time on task was
68% on one observation and 59% on another (both took place in
October). The school counselor
noted that StudentA also participated in one of her groups.
Several times he had to be reminded
of the group rules. On one occasion he had to be asked to
return to his classroom due to his poor
behavior. He was the only one in the group asked to do this.
Observation by the school psychologist during evaluation found
that StudentA was very
interested in the things in his environment and appeared to be
easily distracted. At times, his
distracted could have been purposeful avoidance of difficult (or
at least perceived to be difficult)

tasks, but at other times came about during easy or non-task
(transition) times. StudentA was
very active during assessment, often moving in his chair and/or
playing with something while
responding. He responded well to a game where he was told
that he had set a “world record”
when finished with subtests from the assessment. StudentA was
very motivated to try and set
“world records” and worked very hard when reminded of the
possibility. It appeared that
StudentA was more capable of task completion than he let on,
and when properly motivated, it
appeared that he was able to engage and work hard. During
interview with StudentA prior to
testing, and prior to the world record game, he often responded
to questions with “I don’t know.”
It appeared that such was more of a defense than accurate, and
that in fact he did know, but had to
be motivated to attempt to figure out the answer.
C. Recommendations by teachers:
StudentA’s teacher noted that reading intervention worked for
StudentA. He enjoyed working

one-on-one and/or in small groups. Behavior plans worked at
times, but not always, and need to
be adjusted on a regular basis to keep him interested. His
teacher noted that she had observed
many positive changes in StudentA during his 2nd grade year.
D. The student’s physical condition (include health, vision,
hearing); social or
cultural background; and adaptive behavior relevant to the
student’s suspected
disability and potential need for special education:
There was no evidence to suggest that health, vision, or hearing
were a major concern for
StudentA and the report from the school nurse was
unremarkable. There was a lack of evidence
to suggest that social or cultural background did or did not
present as notable barriers to success.
StudentA did not present with adaptive behavior concerns
beyond the communication concerns
noted by his teacher.

E. Assessments – Include, when appropriate, current classroom
based
assessments; aptitude and achievement tests; local and/or state
assessments;
PA SCHOOL DISTRICT
EVALUATION REPORT
4
behavioral assessments; vocational technical education
assessment results;
interests, preferences, aptitudes (for secondary transition); etc.:
StudentA’s reading progress was monitored through the
Dynamic Indicators of Basic Early
Literacy Skills (DIBELS). His results from kindergarten
through second grade are listed in the
table below:

Kindergarten First Grade Second Grade Third Grade
BOY MOY EOY BOY MOY EOY BOY MOY EOY BOY MOY
EOY
ISF 8 9*
PSF 59 36 47 42
LNF 0** 13** 36* 27*
NWF 3** 18* 11** 30* 43* 23**
ORF 7** 24* 8** 18**
* Strategic **Intensive
Results show that StudentA entered kindergarten with
acceptable phonemic awareness skills
(measured by ISF) but very limited alphabetic principle
knowledge (measured by LNF). By the
end of kindergarten, StudentA had mastered phonemic
awareness (measured by PSF) but
continued to struggle with phonics (measured by LNF and
NWF). On benchmark assessments,
StudentA never mastered his phonics skills (measured through
1st grade and the beginning of 2nd
grade by NWF).
StudentA’s ORF scores (indicator of general reading skill) have

always been in the at risk range.
He showed acceptable growth over the course of the second half
of 1st grade, but regressed a great
deal over the summer and made minimal progress between the
beginning of 2nd grade and the
middle of the year.
The chart below shows StudentA’s progress in reading (ORF) as
measured by progress
monitoring probes given during the second half of 2nd grade.
As can be witnessed in the chart,
StudentA’s middle of the year score of 18 words correctly was
markedly below the grade level
expectation of 68. The end of the year expectation was 90
words read correctly in a minute, and
the expected growth rate, or rate of improvement (RoI) was
about 1.5 words per week. As of
April, StudentA’s highest probe was measured at 33 words
correct per minute and his rate of
improvement, calculated based on a linear regression formula,
was about 0.8 words correct per
minute per week. Based on this data, it could be observed that
StudentA was reading
significantly slower than his same grade peers and he was
making growth at a delayed pace

compared to his peers. Such is remarkable in-and-of-itself, but
is of more concern when the
increased intensity of his reading instruction and intervention
are considered. StudentA received
all the regular education instruction as the rest of his 2nd grade
peers, but also received 30 minutes
per day, five days per week, of instruction from the Phonics for
Reading program, 10 minutes per
day, five days per week, of instruction from the Six Minute

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